OXYMORPHONE HYDROCHLORIDE 7.5 mg Tablet, Film Coated, Extended Release
Coverage in Louisiana (CMS PDP Region 21).
2 of 10 stand-alone Part D plans in Louisiana cover this drug on tier 4.
2 of 2 plans apply a prior authorization, step therapy or quantity limit.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| HealthSpring Assurance Rx (PDP)$48.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $5.4545 | $49.099 units |
|
| HealthSpring Extra Rx (PDP)$60.60/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $5.4545 | $49.099 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity.